| NPI | 1558550566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD432904) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH LT4142) |
| 208600000X Surgery (Licence: NH 20279) | |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2020-02-26 |